Infective endocarditis - emergency medicine revision
Overview
Infective endocarditis (IE) is microbial infection of the endocardial surface, most commonly valves, producing vegetations of platelets, fibrin and organisms. It is uncommon in the general population but carries high morbidity and mortality if not identified and managed early.
Emergency clinicians frequently make the initial diagnosis, perform resuscitation, obtain definitive microbiology samples and initiate liaison with cardiology, cardiothoracic surgery and infectious diseases/microbiology.
Epidemiology and who is at increased risk
- Incidence in developed countries ≈ 2-6 per 100,000 per year; markedly higher in people who inject drugs.
- Typical modern patient is older (median age commonly in the 60s).
- Patients at increased risk include those with:
- prosthetic heart valves;
- prior endocarditis;
- certain congenital heart diseases;
- significant valvular disease (rheumatic or calcific);
- cardiac implantable electronic devices (CIEDs);
- people who inject drugs (IVDU).
- See NICE CG64 for official risk‑group definitions and patient information.
Pathophysiology - key points for the ED clinician
- Endothelial damage or foreign material (prosthetic valve, device lead) leads to platelet and fibrin deposition forming sterile vegetations.